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Osteomalacia

Definition

Osteomalacia is a disease usually resulting from a vitamin D shortage in adults. It causes bones to soften and weaken.

Causes

Vitamin D controls how calcium is absorbed in the body. It also controls levels of calcium and phosphate in bone. Vitamin D is absorbed in the intestines from food. Vitamin D is also produced by the skin during exposure to sunlight.

Osteomalacia is usually caused by vitamin D shortage in the body. This may occur when:

  • The supply of vitamin D from diet or sun exposure is too low
  • Tissue does not respond to the action of vitamin D
  • The way the body processes vitamin D is not typical due to:
    • Disorders of the kidneys, liver, or pancreas
    • Diseases of the small intestines
    • Cancer
    • Certain medications, such as seizure medication and outdated tetricycline
    • Toxicity or poisoning from cadmium, lead, or aluminum

Risk Factors

Osteomalacia is more common in adults 50-80 years of age. It is also more common in people of African American descent.

Factors that can increase your chances of getting osteomalacia include:

  • Lack of sun exposure
  • Lactose intolerance with low intake of vitamin D-fortified milk
  • Family history of rickets

Symptoms

Symptoms may include:

  • Bone pain and tenderness
  • Skeletal and/or skull deformities
  • Bow legs or knock knees
  • Deformity or curvature of the spine
  • Pigeon chest—a chest that protrudes
  • Short stature
  • Susceptibility to bone fractures
  • Dental deformities
  • Increased cavities
  • Loss of appetite or weight loss
  • Difficulty sleeping
  • Poor muscle development and tone
  • Muscle weakness
Curvature of the Spine
IMAGE
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Diagnosis

You will be asked about your symptoms and medical history. A physical exam will be done.

Your bodily fluids and bone may be tested. This can be done with:

  • Blood
  • Urine tests
  • Bone biopsy—when other tests are not conclusive

Pictures may be taken of structures inside your body. This can be done with an x-ray.

Treatment

Treatment attempts to correct the underlying cause and relieve or reverse symptoms.

Treating the Underlying Cause

Treatment of the underlying cause may include:

  • Increasing your intake of vitamin D by adding:
    • Vitamin D-fortified dairy products
    • Foods high in vitamin D, such as fatty fish, egg yolk, and green vegetables
    • Supplements of vitamin D, calcium, and other minerals
    • Biologically active vitamin D
  • Adequate, but not excessive, exposure to sunlight
  • Increased intake of calcium or phosphorus if necessary

Treating Symptoms

Treatment to relieve or correct symptoms may include:

  • Medication for pain
  • Wearing braces to reduce or prevent bony deformities
  • Surgery to correct bony deformities in severe cases

Prevention

To help prevent osteomalacia:

  • Drink vitamin D-fortified milk.
  • Consume enough vitamin D, calcium, and other minerals. If you think your diet may be deficient, talk with your doctor about alternate sources of vitamins and minerals.
  • Get sufficient, but not excessive, exposure to sunlight. 15 minutes a day is usually considered sufficient. Any longer than that requires sun protection with clothing or sunscreens, especially if you have fair skin. People with dark skin may need more sun exposure and dietary supplementation with vitamin D.

Revision Information

  • Eat Right—Academy of Nutrition and Dietetics

    http://www.eatright.org

  • National Institute of Arthritis and Musculoskeletal and Skin Diseases

    www.niams.nih.gov

  • Bone and Joint Canada

    www.boneandjointcanada.com

  • Health Canada

    www.hc-sc.gc.ca

  • Grant WB, Boucher BJ. Requirements for Vitamin D across the life span. Biol Res Nurs. 2011;13(2):120-133.

  • Hypophosphatemia. EBSCO DynaMed Plus website. Available at: http://www.dynamed.com/topics/dmp~AN~T115235/Hypophosphatemia. Updated April 8, 2015. Accessed February 18, 2016.

  • Osteomalacia. Arthritis Research UK website. Available at: http://www.arthritisresearchuk.org/arthritis-information/conditions/osteomalacia.aspx. Accessed February 18, 2016.

  • Osteomalacia. Cleveland Clinic website. Available at: http://my.clevelandclinic.org/orthopaedics-rheumatology/diseases-conditions/hic-osteomalacia.aspx . Accessed February 18, 2016.

  • Vitamin D deficiency in adults. EBSCO DynaMed Plus website. Available at: http://www.dynamed.com/topics/dmp~AN~T113821/Vitamin-D-deficiency-in-adults. Updated October 5, 2015. Accessed February 18, 2016.

  • Vitamin D deficiency in children. EBSCO DynaMed Plus website. Available at: http://www.dynamed.com/topics/dmp~AN~T181112/Vitamin-D-deficiency-in-children-infancy-through-adolescence. Updated February 3, 2015. Accessed October 4, 2016.